Table 4.
Erlangen symptom score used to quantify unrestricted diet, hypoallergenic diet and reactions during blinded, placebo-controlled food challenges (BPCFC)
| I. General symptoms | |||||||
| 1. Reduction of general condition | 2. Core temperature | ||||||
| Mild | 1 | Subfebrile; 37,5 to 38,0°C | 1 | ||||
| Moderate | 2 | Low fever; 38,0 to 39,0°C | 2 | ||||
| Severe | 3 | High fever; >39,0°C | 3 | ||||
| Intolerable | 4 | ||||||
| II. Organotropic symptoms | |||||||
| 1. Eyes | 2. CNS | ||||||
| - Itching/burning | - Conjunctiva | - Headache/vertigo | - Sensitivity | ||||
| Mild | 1 | Erythema | 1 | Mild | 1 | Paresthesia | 1 |
| Moderate | 2 | Swelling unilateral | 2 | Severe | 2 | Prickling | 1 |
| Continuous | 3 | Swelling bilateral | 3 | Migraine | 3 | Heat (feeling) | 1 |
| 3. Cardiovascular system | |||||||
| Decrease of blood pressure (systolic) | Increase of heart rate | ||||||
| >10 mm hg | 3 | >10/min | 3 | ||||
| >20 mm hg | 6 | >20/min | 6 | ||||
| >30 mm hg | 10 | >30/min | 10 | ||||
| 4. Respiratory systems | |||||||
| - Nasal congestion | - Prickling/itching (nose & pharynx) | ||||||
| Unilateral | 1 | Occasional | 1 | ||||
| Bilateral | 2 | With rubbing | 2 | ||||
| Mouth breathing | 3 | Continuous | 3 | ||||
| - Rhinorrhea | - Sneezing | ||||||
| Occasional | 1 | Occasional | 1 | ||||
| Frequently | 2 | Frequently | 2 | ||||
| Continuous | 3 | Continuous | 3 | ||||
| - Larynx | - Pulmonary function test | ||||||
| Hoarseness | 2 | FEV1 80–60% / PEF <75% (baseline) | 2 | ||||
| Laryngeal edema | 5 | FEV1 < 60% / PEF < 50% (baseline) | 5 | ||||
| - Bronchial obstruction (auscultatory) | - Cough | ||||||
| Expiratory wheezing | 2 | Occasional | 1 | ||||
| In- & expiratory wheezing | 5 | Frequently | 2 | ||||
| Massive obstruction (silent lung) | 10 | Staccato cough | 3 | ||||
| 5. Gastrointestinal tract | |||||||
| - Buccal cavity | - Abdomianl pain/cramps | ||||||
| Erythema/thumbness | 1 | Mild | 1 | ||||
| Swelling | 2 | Moderate | 2 | ||||
| Aphts | 3 | Severe | 3 | ||||
| - Esophagus | - Diarrhea | ||||||
| Pain | 1 | Loose | Number of stools x 1 | ||||
| Dysphagia/pyrosis | 2 | Liquid | Number of stools x 2 | ||||
| Bolus (feeling) | 3 | Bloody | Number of stools x 3 | ||||
| - General | |||||||
| Meteorism | 1 | ||||||
| Nausea | 1 | ||||||
| Vomiting | Episodes x 2 | ||||||
| 6. Locomotor apparatus | |||||||
| - Arthralgia (including spinal column) | - Arthritis (with joint effusion) | ||||||
| 1 joint | 1 | 1 joint | 1 | ||||
| 2–4 joints | 2 | 2–4 joints | 2 | ||||
| >4 joints | 3 | >4 joints | 3 | ||||
| 7. Skin | |||||||
| - Pruritus | -Erythema | ||||||
| Occasional | 1 | Mild | 2 | ||||
| >2 minutes | 2 | Moderate, <50% body surface | 5 | ||||
| Excoriations | 3 | Generalized, >50% body surface | 10 | ||||
| - Urticaria/angioedema | |||||||
| <3 hives | 2 | ||||||
| 3–10 hives | 5 | ||||||
| Generalized, generalized flush | 10 | ||||||
| Result: | |||||||
| <3 points | Negative result | ||||||
| 3–5 points | Questionable result | ||||||
| >6 points | Positive result | ||||||
Individual reactions and symptoms during the test days with unrestricted diet, potato-rice diet and during the food challenge tests were documented each for a 24 hours period and calculated for the corresponding diet and day, respectively.
Food challenges were only performed when patients had a clear resolution of their symptoms under the hypoallergenic diet with symptom scores < 3 points. Symptom scores higher than 6 points were judged as positive reactions and compared with the score during potato-rice diet [11,12].